TY - JOUR
T1 - Percentage change in hemoglobin level and morbidity in spine surgery patients
AU - Purvis, Taylor E.
AU - Goodwin, C. Rory
AU - Molina, Camilo A.
AU - Frank, Steven M.
AU - Sciubba, Daniel M.
N1 - Funding Information:
Dr. Frank: consultant for Haemonetics and Medtronic. Dr. Good-win: a United Negro College Fund Merck postdoctoral fellow and received an award from the Burroughs Wellcome Fund and the Johns Hopkins Neurosurgery Pain Research Institute. Dr. Molina: consultant for Augmedics. Dr. Sciubba: consultant for DePuy-Synthes, Medtronic, Stryker, K2M, Globus, and Orthofix.
Publisher Copyright:
© AANS 2018.
PY - 2018/3
Y1 - 2018/3
N2 - OBJECTIVE: The aim of this study was to characterize the association between percentage change in hemoglobin (ΔHb) - i.e., the difference between preoperative Hb and in-hospital nadir Hb concentration - and perioperative adverse events among spine surgery patients. METHODS: Patients who underwent spine surgery at the authors' institution between December 4, 2008, and June 26, 2015, were eligible for this retrospective study. Patients who underwent the following procedures were included: atlantoaxial fusion, subaxial anterior cervical fusion, subaxial posterior cervical fusion, anterior lumbar fusion, posterior lumbar fusion, lateral lumbar fusion, excision of intervertebral disc, and excision of spinal cord lesion. Data on intraoperative transfusion were obtained from an automated, prospectively collected, anesthesia data management system. Data on postoperative hospital transfusions were obtained through an Internet-based intelligence portal. Percentage ΔHb was defned as: ([preoperative Hb - nadir Hb]/preoperative Hb) × 100. Clinical outcomes included in-hospital morbidity and length of stay associated with percentage ΔHb. RESULTS: A total of 3949 patients who underwent spine surgery were identified. Of these, 1204 patients (30.5%) received at least 1 unit of packed red blood cells. The median nadir Hb level was 10.6 g/dl (interquartile range 8.7-12.4 g/dl), yielding a mean percentage ΔHb of 23.6% (SD 15.4%). Perioperative complications occurred in 234 patients (5.9%) and were more common in patients with a larger percentage ΔHb (p = 0.017). Hospital-related infection, which occurred in 60 patients (1.5%), was also more common in patients with greater percentage ΔHb (p = 0.001). CONCLUSIONS: Percentage ΔHb is independently associated with a higher risk of developing any perioperative complication and hospital-related infection. The authors' results suggest that percentage ΔHb may be a useful measure for identifying patients at risk for adverse perioperative events.
AB - OBJECTIVE: The aim of this study was to characterize the association between percentage change in hemoglobin (ΔHb) - i.e., the difference between preoperative Hb and in-hospital nadir Hb concentration - and perioperative adverse events among spine surgery patients. METHODS: Patients who underwent spine surgery at the authors' institution between December 4, 2008, and June 26, 2015, were eligible for this retrospective study. Patients who underwent the following procedures were included: atlantoaxial fusion, subaxial anterior cervical fusion, subaxial posterior cervical fusion, anterior lumbar fusion, posterior lumbar fusion, lateral lumbar fusion, excision of intervertebral disc, and excision of spinal cord lesion. Data on intraoperative transfusion were obtained from an automated, prospectively collected, anesthesia data management system. Data on postoperative hospital transfusions were obtained through an Internet-based intelligence portal. Percentage ΔHb was defned as: ([preoperative Hb - nadir Hb]/preoperative Hb) × 100. Clinical outcomes included in-hospital morbidity and length of stay associated with percentage ΔHb. RESULTS: A total of 3949 patients who underwent spine surgery were identified. Of these, 1204 patients (30.5%) received at least 1 unit of packed red blood cells. The median nadir Hb level was 10.6 g/dl (interquartile range 8.7-12.4 g/dl), yielding a mean percentage ΔHb of 23.6% (SD 15.4%). Perioperative complications occurred in 234 patients (5.9%) and were more common in patients with a larger percentage ΔHb (p = 0.017). Hospital-related infection, which occurred in 60 patients (1.5%), was also more common in patients with greater percentage ΔHb (p = 0.001). CONCLUSIONS: Percentage ΔHb is independently associated with a higher risk of developing any perioperative complication and hospital-related infection. The authors' results suggest that percentage ΔHb may be a useful measure for identifying patients at risk for adverse perioperative events.
KW - Anemia
KW - Blood loss
KW - Diagnostic technique
KW - Hemoglobin
KW - Morbidity
KW - Surgery
KW - Transfusion
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U2 - 10.3171/2017.7.SPINE17301
DO - 10.3171/2017.7.SPINE17301
M3 - Article
C2 - 29271728
AN - SCOPUS:85042698504
SN - 1547-5654
VL - 28
SP - 345
EP - 351
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
IS - 3
ER -